31 Exploring the concept inability to work fulltime in the context of work disability assessments Most participants (both physicians and patient representatives) mentioned the value of clinical tests, separately or in combination with other methods, as methods for assessing indicators of inability to work fulltime, such as fatigue and cognitive problems, and not just inability to work fulltime in itself. As a physician explained, “Testing with neuropsychological assessment and ergometry (exertion-tests and VO2max-determination) contributes to the assessment of inability to work fulltime, but is not the final answer” (Ph6); this applies especially to certain disorders or conditions like traumatic brain injury, and heart and lung diseases. Both physicians and patient representatives regarded trial placements and observation at work as appropriate ways to discover the extent of a person’s capacity to work. This trial and error setting makes it possible to test and observe indicators of inability to work fulltime. As a patient representative stated, “Observe if someone makes mistakes or takes rest during trial placement” (Pa5). Participants indicated a need for repeated observations and long-term follow-up, suggesting periods from six weeks to three months. DISCUSSION In this study we aimed to conceptualize and operationalize the concept inability to work fulltime by interviewing physicians and patient representatives and analyzing their answers. Our results show that inability to work fulltime describes the inability to work normal working hours and is considered a complex concept to operationalize, as it is strongly individually determined and variable. The underlying disease and changes in the situation over time make the concept variable. Moreover, we found that key dimensions of inability to work fulltime included not only the disease itself, but also personal factors like lifestyle and psychological components, as well as environmental factors related to the work situation and conceptions regarding what constitutes a ‘normal’ number of working hours. Fatigue, cognitive impairments, and restrictions in functioning in- and outside work were reported as important measurable indicators of inability to work fulltime. To assess this inability, participants regarded assessment interviews, testing, and evaluation in the actual work setting as the most suitable methods for measuring indicators, and expressed a preference for their combined use. They also mentioned the importance of repeated assessment, given the longitudinal and variable nature of inability to work fulltime. Self-assessment methods alone were not considered suitable. In all, the results of this study provide insight into the key elements (characteristics and dimensions) of inability to work fulltime, some important measurable indicators, and methods that can be used for assessment. Our results thus contribute to more evidence-based work disability assessments. 2
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